How to handle your Comrades Marathon recovery
01 January 1970
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Brad Brown: You’re listening to Old Mutual Live, great things start here, great things start now and wow, the dust has settled following Comrades 2016, just barely. It’s the day after and what an incredible day it was. We hope you enjoyed our live broadcast over the last four days and particularly on Comrades race day. But it’s time to get back down to business.
We thought we’d take a look at something while it’s calm, before the storm hits. We wanted to chat a little bit about recovering after a race like Comrades. We’re joined now by one of the leading sports physicians in the country. He’s based in Morningside, Dr Jon Patricios. Jon, welcome, thanks for joining is today, thanks for your time.
John Patricios: Good day, pleasure to be with you.
BB: Doc, Comrades Down run is brutal, I say the Comrades Down run, Comrades in general is brutal on the body. But the Down run particularly so. I mean now is the time for runners to not even think about doing anything else. They just really need to get their body back in order.
JP: I think you’re quite right. The Down run, yes, it is a little bit more taxing on the body, but that doesn’t mean the Up run is easy. The reason for that is there’s more, what we call eccentric load on the body. In other words, your muscles stretch out a little bit more as they take the impact. That tends to put a little bit more stress on the muscle and you get a little bit more, what we call delayed onset muscle soreness. That ache that runners will feel day one, two and three after an event.
Certainly, they’ll be feeling it this morning and maybe for a day or two to come, but if they’re well enough conditioned, they should recover pretty well. I think what you’re really implying, which is quite right, is they need a strategy now to recover. Then to move forward in terms of trying to prepare for their next event and the next Comrades if necessary.
The different aspects of recovery
BB: We know everyone said yesterday ‘never again’, but minds have been changed this morning, haven’t they?
JP: Absolutely! I think in the last 10km, as they were coming in to Durban, a lot of them were thinking, what on earth is going on here, those that were thinking at all, but absolutely. I think once the medals around your neck, it certainly gives that feeling of achievement.
They may not think about it immediately but one of the points I think you’re raising is there needs to be an element of mental recovery. Let’s look at the different aspects of recovery. I think a lot of emotional energy goes into the Comrades Marathon preparation and after you have that medal, I think it’s important to just step away and just forget about all the things that you’ve done. Just try and divert a little bit, to give your body and your mind a rest.
Have that extra beer, have that extra block of chocolate, all the things you’ve been denying yourself, there’s no harm really in just allowing yourself to go a little bit, for a few days. Just let yourself mentally have a holiday from the strenuous preparation that goes into an endurance event like that.
Stay away from running, not just to let your body recover, but just to give yourself a mental break. It’s also the middle of winter, it’s been tough. From the middle of May, in preparing now for an event like this, it’s good to just give yourself a lie in and allow yourself mentally to recovery.
Then also, from a physical point of view, to allow your muscles a real break, to repair. What people don’t always realise is there’s damage. The body undergoes quite a considerable amount of wear and tear, not only in the preparation, but particularly on race day.
Some damage that occurs and it needs time to recover. That’s rest, it’s things like massages etc, and it’s a change of routine. Perhaps, for some people it’s a week, for others it’s 3-4 weeks, for others it’s three months that you need to recover.
Then, the last thing I’d like to comment on is really use the opportunity to address any of the niggles that occurred during the race and in the preparation for the race. There may have been things which were worrying you, maybe you got away with them, maybe they cut you down in the race. Don’t leave it too long before you get those addressed because although they may feel as if they recover; if you don’t address the underlying causes, then these are going to come back and bite you again in your preparation for the next event.
Warning signs that your recovery is a health issue
BB: Doc, you mentioned a couple of important things there, with regards to recovery and I think it’s also important to mention that it is normal to be sore after a Comrades Down run. If you’re not sore, you obviously didn’t push hard enough. But this time and you mentioned the delayed onset of muscle stiffness, the bad news is, it’s probably going to be worse tomorrow than it is today and then it starts easing up.
When should people start worrying that they’re still in pain and they’re still battling with soreness and might need medical attention to get something sorted out? Are there warning signs? What are the most common things that you see in this period after Comrades?
JP: That’s an excellent point Brad and I think we need to distinguish between just normal delayed onset of stiffness from a race, that’s part of the recovery process. Actually a medical condition which is known as Rhabdomyolysis. Where there is actual severe breakdown of the muscles and release of proteins into the blood and a negative effect on the kidney function.
What are the warning signs? The warning signs would be, in the severest form, things like collapse. In a less blatant form, things like really severe muscle pain. Not innate, but severe muscle pain, often associated with swelling and tenseness in the muscle. Then very importantly, any significant change in the colour of the urine.
If the urine is appearing dark, some people refer to it as a Coca-Cola colour, that is a really bad sign. It means that those proteins are being deposited in the kidneys and are placing you at significant health risk and if that’s the case, then you need to get to a hospital and/or a doctor as soon as possible and have that attended to.
If, in the normal process of rehydration, the urine is reasonably clear and the muscles are achy, but you’re able to move around, albeit a bit stiffly, then you should respond just to rest/recovery, a bit of massage etc. But the rehydration process and the replenishment process is very important for everybody.
BB: A lot of runners will tell you that the day after or the two days afterwards, that’s all they do and the best recovery drink for them is an ice cold beer. But I think the jury is still out on that, but runners, I think, will argue until the death!
JP: Absolutely and I don’t deny them that beer, but I do think they need to get the traditional rehydration fluids into them, in the first hour or two after the race, before touching a beer. I think that’s very important, to rehydrate, replenish, get some good urine flow going, to make sure that the kidneys are functioning properly and then to let that mental stress release a little bit.
How and when to start running again
BB: And it’s also important, I think Doc, and it’s just a point I want to make, is it’s not just taxing on you, it’s been taxing on your loved ones as well, your family and if you’ve got kids. So it is time to, I don’t want to say give something back, but to forget about running for a little while. Let’s talk about getting back on the road and when people should.
There’s no real rule of thumb, but is it a case of when you feel you’re ready you should go and if there’s any pain, back off. How do you get started again, after a race like Comrades? Do you carry on running the crazy distances you were running in the build-up or do you have to start slowly again to avoid overuse injuries?
JP: I think my approach is that planning for a Comrades Marathon needs to be very similar to how one plans for one’s career or work. In other words, there needs to be some sort of forethought going into the process and the scheduling of events over a year.
Comrades would be one of the events in your running or in your endurance programme or preparation and there needs to be the rest of the programme that’s been thought of carefully. Part of that programme will be an off season.
One might say, right, my off-season will be during the winter where I’m actually not going to do any running. Some people will choose not to run for 3-4-6 weeks after the Comrades Marathon and that may mean a period of cross training. Maybe the bicycle or an indoor pool, maybe on a rowing machine, something like that. But there needs to be some sort of rest and recovery period built into your years schedule.
Also, you need to look at periods of higher intensity and stress and other periods of lower intensity and stress. You can’t run 90km races every second week. This would be probably the ultra race of the year, maybe with a Two Oceans thrown in, maybe one or two other marathons which you’re going to do during the year. Then vary it by throwing in 21’s, 10’s, 15’s etc. There’s got to be what we call a ‘periodisation’.
Why do we periodise, it really means that you break your year up into different intensities, over different periods. Because the body responds really well to recovery, after a period of stress. If you keep exposing yourself to endurance events without allowing recovery, including active recovery; it doesn’t mean you rest totally, then your body just breaks down all the time. You need to do high intensity, you need to do low intensity, you need to do higher distance, you need to do shorter distances and you need to allow your body to recovery.
That’s very important, so I really encourage my running patients to plan their year, where you have periods of quite intense preparation, periods of less intense preparation and periods of no running at all. Where you’ll actually rest and cross train and that will depend on people’s plans for the year. You’ve got to build that in and as you say, family comes into that and you need to work that in because endurance sport is quite a selfish activity.
BB: That it is, Dr Jon Patricios, thank you so much for your time here on Old Mutual Live, I think that’s some sound advice. My advice to people would be to hang out on the dark side for a while and get back into it slowly. Thanks a lot, much appreciated, we look forward to catching up again soon.
JP: You’re welcome, good luck.